血液透析患者家庭照顾者生活质量量表汉化及信效度检验

目的 汉化血液透析患者家庭照顾者生活质量量表,检验其信效度。 方法 采用Brislin模式将英文版血液透析患者家庭照顾者生活质量量表翻译成中文,采用中文版量表对738名血液透析患者家庭照顾者进行调查,检验量表信效度。 结果 中文版量表各条目水平的内容效度指数为0.848～1.000,量表水平的内容效度指数为0.935,探索性因子分析提取5个公因子,共35个条目,累积方差贡献率为64.172%。验证性因子分析的模型适配度良好。总量表Cronbach′s α系数为0.831,5个公因子的Cronbach′s α系数为0.694～0.821,重测信度为0.886。中文版量表总分与ZBI照顾者负担量表总分相关系数为-0.821（P＜0.05）。 结论 中文版血液透析患者家庭照顾者生活质量量表具有较好的信效度,适用于我国血液透析患者家庭照顾者生活质量测量。     

艾滋病患者症状自评量表简体中文版的信效度检验

目的检验艾滋病患者症状自评简体中文版量表(SSC-HIV-SC)的信效度。方法对繁体中文版SSC-HIV-C进行文字表述调整,对大陆地区302例艾滋病患者进行测试,评价SSC-HIV-SC内部一致性,检验量表的内容效度、结构效度和效标效度。结果 SSC-HIV-SC的内容效度为0.95,主成分法提取11个公因子,累积方差贡献率为57.383%;SSC-HIV-SC总分与研究对象的生活质量量表各维度得分呈负相关(r=-0.202~-0.602,均P0.01);总量表的Cronbach′sα系数为0.913。结论 SSC-HIV-SC具有较好的信度和效度,可作为我国艾滋病患者相关症状的测量工具。     

父母疾病进展恐惧量表的汉化及在癌症患儿父母中的信效度检验

目的 汉化父母疾病进展恐惧量表,并在癌症患儿父母中检验其信效度.方法 通过翻译、回译、文化调适和预试验形成中文版父母疾病进展恐惧量表,对广州市3所三甲医院癌症患儿父母329人进行问卷调查,以检验中文版量表的信效度.结果 中文版父母疾病进展恐惧量表包括情感反应、家庭生活和学校3个维度共12个条目.量表水平的内容效度指数为...     

中文版特异性用药信念量表应用于2型糖尿病患者的信效度检验

目的汉化适用于2型糖尿病患者的特异性用药信念量表,并在2型糖尿病患者中检测其信效度。方法对特异性用药信念量表进行翻译、回译等,采用便利抽样法抽取118例2型糖尿病患者进行调查,检验量表的内部一致性信度、重测信度、内容效度、结构效度和判别效度。结果中文版特异性用药信念量表2个维度的Cronbach′sα系数分别为0.749和0.796;重测信度分别为0.809和0.751。量表各条目的内容效度指数为0.857～1.000,量表的平均内容效度指数为0.980。探索性因子分析提取2个公因子,分别为用药顾虑和用药必要性,解释总方差的62.25%。高分组患者的得分显著高于低分组患者(P0.01)。结论中文版特异性用药信念量表运用于我国2型糖尿病患者具有良好的信效度,可用于测量2型糖尿病患者用药信念。     

幼儿父母家庭赋能量表的汉化及信效度检验

目的 对日文版幼儿父母家庭赋能量表进行汉化,并检验其信效度。方法 获得量表原作者授权,采用Brislin双人翻译-回译法,对日文版量表进行翻译、回译、整合、文化调适及预调查,形成中文版量表。应用中文版幼儿父母家庭赋能量表对539名幼儿父母进行调查,检验量表的信效度。结果 中文版幼儿父母家庭赋能量表包括家庭关系、育儿的自我效能感、与当地社区间的联系、父母角色成就感、育儿服务的认知和有效利用5个维度共24个条目,量表的条目水平的内容效度指数为0.857～1.000,量表水平的平均内容效度指数为0.907;探索性因子分析提取出5个公因子,累计方差贡献率为74.956%;验证性因子分析结果显示,χ2/df=1.486,RMSEA=0.048,NFI=0.941,IFI=0.980,TLI=0.977,CFI=0.980,GFI=0.869,AGFI=0.838,整体模型拟合度可接受。量表的Cronbach′s α系数为0.946,各维度的Cronbach′s α系数为0.908～0.949;量表折半信度为0.801。结论 中文版幼儿父母家庭赋能量表具有较好的信效度,可以作为幼儿父母家庭赋能筛查的测评工具。     

安宁疗护沟通舒适度量表汉化及信效度检验

目的 对安宁疗护沟通舒适度量表进行汉化，并检验其在医护人员中应用的信效度。方法 依据跨文化调适指南对英文版量表进行直译、回译、跨文化调适、预调查后对量表进行修订，形成中文版安宁疗护沟通舒适度量表。采用便利抽样法对527名医护人员进行调查，检验中文版量表的信效度。结果 中文版量表包括团队考虑、处理医疗决策、精神考虑、处理症状、慎重意识、文化考虑共6个维度，累积方差贡献率为80.349%;条目水平的内容效度指数为0.860～1.000,量表平均内容效度指数为0.980;Cronbach′s α系数为0.910,重测信度为0.869。结论 中文版安宁疗护沟通舒适度量表信效度良好，可作为测量我国医护人员安宁疗护沟通舒适度的工具。     

癌症患者临终沟通准备度量表的汉化及信效度检验

目的 汉化癌症患者临终沟通准备度量表,并检验其信度和效度。方法 获取量表原作者授权后,采用Brislin翻译模式对英文版癌症患者临终沟通准备度量表进行翻译、回译、文化调适,形成中文版量表;对242例晚期癌症患者进行调查,以评价量表的信效度。结果 中文版癌症患者临终沟通准备度量表包含沟通思想准备、沟通经验、价值观3个维度,共12个条目,累积方差贡献率为76.985%,量表Cronbach′s α系数为0.910,各维度的Cronbach′s α系数为0.869～0.919;Spearman-Brown折半信度为0.699,重测信度为0.872。量表水平的内容效度指数为0.917。结论 中文版癌症患者临终沟通准备度量表具有较好的信度和效度,可用于评价我国癌症患者临终沟通准备状况。     

家庭肠内营养健康相关生活质量问卷的汉化及信效度评价

目的 对家庭肠内营养健康相关生活质量问卷进行汉化,并在炎症性肠病行家庭肠内营养患者中进行信效度检验.方法 对英文版问卷进行翻译和跨文化调适,形成中文版本.采用方便抽样法,选取185例行家庭肠内营养患者进行调查,评价中文版本的信效度.结果 中文版问卷保留原17个条目,包括身体功能(14个条目)、日常活动和社会生活(3个条目)2个维度.2个因子累积方差贡献率为52.676％.内容效度指数为0.96.总问卷Cronbach's α系数为0.904,折半信度系数0.899,重测信度为0.709.结论 中文版家庭肠内营养健康相关生活质量问卷具有良好的信效度,可以作为我国家庭肠内营养患者生活质量的评估工具.     

口服抗凝治疗护理管理自我效能量表的汉化及信效度检验

目的 汉化口服抗凝治疗护理管理自我效能量表（Self-Efficacy Scale for Oral Anticoagulant Nursing Therapy Management，SE-OAM），检验其信效度，为临床提供合适的评估工具。 方法 对原量表进行翻译、综合、回译，经文化调适后形成中文版SE-OAM；对292名护士进行正式调查，在调查2周后从中便利抽取20名护士再次填写量表，检验量表信效度。 结果 中文版SE-OAM共5个维度21个条目，项目分析高、低分组各条目评分比较，t=16.380~22.830（均P＜0.05），相关系数0.762～0.935；I-CVI为0.870～1.000，S-CVI/Ave为0.970。探索性因子分析共提取出5个公因子，累计方差贡献率71.279%。总量表Cronbach′s α系数为0.982，重测信度为0.971。 结论 中文版SE-OAM信效度较好，可用于测量护士在患者口服抗凝治疗管理中的自我效能水平，为护理管理者制定针对性的自我效能提高方案提供依据。     

安宁疗护志愿者动机量表的汉化及信效度检验

目的 汉化安宁疗护志愿者动机量表,并检验其信效度,以期为我国安宁疗护志愿者动机测量提供工具.方法 应用Brislin模式对安宁疗护志愿者动机量表进行翻译,根据文化调适和预调查对量表进行修订,形成中文版量表.采用便利抽样方法对北京市、天津市260名安宁疗护志愿者进行调查,以检验中文版量表的信效度.结果 中文版量表包括利他主义、公民责任、自我提升、休闲和个人收益5个维度共25个条目.量表条目水平的内容效度(I-CVI)为0.833～1.000,量表水平的内容效度(S-CVI)为0.973;探索性因子分析共提取5个公因子,累积方差贡献率73.390％.量表的Cronbach's α系数为0.934,各维度的Cronbach'sα系数为0.896～0.917;折半信度为0.868;总量表的重测信度为0.913,各维度的重测信度为0.732～0.957.结论 中文版安宁疗护志愿者动机量表信效度良好,可作为评估我国安宁疗护志愿者动机的工具.     

Anaesthetic implications of anorexia nervosa

The provision of anaesthesia for patients suffering from anorexia nervosa or bulimia nervosa is not without its risks. The anaesthetist needs to appreciate that these eating disorders can predispose the patient to significant risk of multi-organ dysfunction related to starvation and purging. Any such organ dysfunction can have serious implications on morbidity and mortality. Therefore, careful peri-operative management is essential to avoid anaesthetic complications. Both disorders are common, with incidences in the general population of up to 30% in girls and young women. A review of the literature on the provision of anaesthesia for anorexic patients was carried out to evaluate the potential impact of these disorders on the patient's physiology and the subsequent implications for anaesthesia.     

Evaluation of Bone Loss and Its Mechanisms in Anorexia Nervosa

The purpose of this cross-sectional study was to assess the extent of and mechanisms involved in bone loss in anorexia nervosa patients. We compared 113 anorexia nervosa patients (mean age 25 ± 8 years, mean duration of disease 5.7 ± 6.1 years) with 21 age-matched controls. Mean duration of amenorrhea was 3.2 ± 4.7 years. We measured serum calcium and phosphate; bone remodeling markers (osteocalcin, bone-specific alkaline phosphatase [BSAP], serum crosslaps [CTX], and carboxyl-terminal telopeptide of type I collagen [ICTP]); follicle-stimulating hormone and luteinizing hormone levels; and estradiol (ultrasensitive assay), cortisol, urinary free cortisol, thyroid function, prolactin, and nutritional factors (insulin-like growth factor I [IGF-I], IGF binding protein 3 [IGFBP3]). In controls, only bone remodeling markers and nutritional factors were measured. Osteodensitometry was also performed on both patients and controls. Weight and body mass index (BMI) were significantly lower in anorexia nervosa patients than in controls (P < 0.0001). No significant differences were observed in biological indicators except for IGF-I, which was lower in anorexia nervosa patients (0.9 ± 0.4 UI/mL) than in controls (1.5 ± 0.4 UI/mL) (P < 0.0001). Densitometric measurements at three sites were significantly lower in anorexia nervosa patients and correlated with duration of disease and amenorrhea and with IGF-I at the hip only (P < 0.01). In the study population, osteoporosis was observed in 24 patients (21%) and osteopenia in 54 patients (48%). Patients with osteoporosis were significantly older and had longer disease and amenorrhea durations; lower weight and BMI; higher alkaline phosphatase, BSAP, and osteocalcin; and lower serum ICTP, IGF-I, and IGFBP3. All of these differences were significant and remained so even after multiple adjustments were made, except for IGF-I (P = 0.21). When multivariate analysis was performed, we found that age at onset of amenorrhea, weight, alkaline phosphatase, urinary free cortisol, and serum estradiol concentration accounted for 54% of the variance in spinal bone mineral density (BMD). Duration of amenorrhea, alkaline phosphatase, and weight explained 46.6% of the variance in femoral neck BMD. Duration of amenorrhea, IGF-I, and ICTP levels accounted for 38.6% of the variance observed in total hip BMD. The etiology of bone loss in patients with anorexia nervosa is multifactorial. Hypoestrogenia alone cannot account for this loss, and nutritional factors, IGF-I concentrations in particular, seem to play an important role.     

Anorexia nervosa and pelvic floor dysfunction

Pelvic floor dysfunction in women with eating disorders is an underexplored area. We present a case of pelvic floor dysfunction in a nulliparous woman with anorexia nervosa.     

Severe eosinophilic cystitis in a woman with anorexia nervosa

Eosinophilic cystitis is a rare inflammatory disorder. It is considered to be self limiting necessitating only supportive therapy. Surgical intervention is unusual. We report here an association between eosinophilic cystitis and anorexia nervosa in an adult woman requiring radical surgery for progressive relentless disease. Estrogen deficiency associated with a possible allergic etiology could explain this association.     

Disordered eating behaviors in type 1 diabetic patients

Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially diff icult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following compo- nents: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight andshape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.     

Increased calcium content and inhomogeneity of mineralization render bone toughness in osteoporosis: Mineralization,morphology and biomechanics of human single trabeculae

Since the advent on non-invasive in vivo clinical bone densitometry, investigators have reported that regional bone mineral material loss accompanies the onset and continuance of anorexia nervosa (AN). Initial single-energy photon absorptiometric (SPA) studies were followed by a succession of dual-energy X-ray absorptiometric (DXA) investigations, and a few single-energy quantitative computer assisted tomographic (SEQCT) bone densitometry vertebral measurements. Although most all DXA studies found a relatively small diminution ( 3%) of bone mineral material at lumbar vertebral and proximal femoral bone-sites of AN-afflicted adolescent girls and young women, these findings have been consensually interpreted and near-universally accepted as losses of actual bone mineral material accompanying AN. It has also been claimed by some that about 50% of those beset by AN while still young adolescents were osteoporotic. Nonetheless, over the last intervening 2 decades of these studies, no specific underlying direct bone-biological causal link between AN and trabecular bone material loss has yet been uncovered. The present exposition shows that in vivo SPA, DXA, and SEQCT measurements of bone mineral material losses do not constitute evidence of actual loss of bone material, and that the attribution of osteopenia and osteoporosis to AN-afflicted younger adolescent girls is not sustainable. Rather, the full gamut of these reported bone material “losses” can be accounted for by the already well-documented AN-induced changes in the anthropometrics and compositional mixes of extra-osseous soft tissues (primarily in a very noticeable reduction of extra-skeletal fat) and intra-osseous bone marrow yellowing (marrow hypoplasia and marrow cell necrosis). These changes in soft tissue compositions and anthropometrics alone have been shown to be sufficient to cause in vivo SPA, DXA, and SEQCT to systematically mis-estimate true bone material density and erroneously register changes in bone mineral content, even when no actual changes in bone mineral material have occurred. As a result, it is seen that in vivo bone densitometry methodologies have not demonstrated that AN induces actual loss of bone mineral material. It is also demonstrated that DXA and SEQCT bone density measurements of predominantly trabecular bone-sites cannot be relied upon as gauges of heightened propensity for early (or late) osteoporotic development.     

A prospective study of changes in bone turnover and bone density associated with regaining weight in women with anorexia nervosa

Anorexia nervosa (AN) is a condition of self-induced weight loss, associated with an intense fear of gaining weight. Previous studies have shown that bone density may increase with regaining and maintaining normal weight; however, relatively little is known about the changes in bone metabolism that occur during weight restoration. We describe the effect of weight restoration and maintenance of weight over 1 year on bone mineral density (BMD) and bone turnover. We recruited women from the eating disorders services at the South West London and St Georges Mental Health NHS Trust, and the Priory and Charter Nightingale Hospitals in London, UK. Details of their AN, fracture history, menstrual history and exercise were obtained by interview and case note review. Morning samples of blood and second void urine were taken for biochemical analysis. BMD was measured by DXA at the lumbar spine (LS), femoral neck (FN), distal radius (RD) and total body bone mineral content (BMC). Patients then entered the treatment program, which includes re-feeding, dietary education and psychotherapy. Over a period of 42 months, we recruited 55 women who agreed to participate in this study and underwent baseline investigations. Of these, 15 (27%) subjects achieved and then maintained their target weight for the duration of the study. At baseline for all subjects ( n =55) estradiol levels were lower than the normal reference ranges (both follicular and luteal phases) in 91% of the women. Bone specific alkaline phosphatase (BSAP) concentrations were lower than the premenopausal reference range in 55% of women, and urinary deoxypyridinoline (DPD) was above the premenopausal reference range in 78% of women. Baseline lumbar spine BMD was positively related to BMI (Pearsons r =0.29, P =0.04) and inversely related to bone turnover markers: urinary DPD (Pearsons r =–0.39, P =0.01 and serum BSAP (Pearsons r =–0.3, P =0.06). The 15 patients who regained and maintained weight were followed-up for a mean duration of 69 weeks (SD 7.3, range 54 to 84 weeks). Mean BMI increased from 14.2 (1.7) to 20.2 (0.77) kg/m² and remained stable throughout follow-up. Menstruation resumed in 8 of the 15 women. Total body BMC and LS BMD increased significantly over the duration of follow-up (by 4.3% each), but FN BMD and distal radius remained stable. Lumbar spine bone area also increased significantly, whereas FN and distal radius did not. These changes were associated with a significant increase in BSAP ( P =0.01), and a non-significant trend for a decrease in DPD ( P =0.10). Our findings suggest that when women are at low body weight they are in a hypo-estrogenic state, which is associated with imbalance of bone turnover (high bone resorption and low bone formation). This is reversed with weight gain and persists as target weight is maintained and is associated with increases in BMC and BMD.There was no conflict of interest.     

Sex differences and similarities of hormonal alterations in patients with anorexia nervosa

The aim of the present study was to gain better insight into hormonal disturbances in male patients with anorexia nervosa. It included six men with anorexia nervosa aged 13-26 years, with a mean body weight of 42.83 +/- 8.03 kg, a body mass index of 15.08 +/- 1.26 and an average degree of weight loss 29.98 +/- 4.73%. The results were compared with those of 15 healthy age-matched males and 40 women with anorexia nervosa. Prolactin, growth hormone and the gonadal and thyroid axis were studied in detail. The gonadotropin basal levels and their responses to gonadotropin-releasing hormone in male patients were lower, but not significantly, in comparison with healthy men. The basal levels and the responses of luteinizing hormone in anorexic women were significantly lower in comparison with female controls, but the decreased basal level of follicle-stimulating hormone showed an exaggerated response to gonadotropin-releasing hormone. In male anorexics the testosterone levels (7.1 +/- 10.9 nmol l-1) were significantly lower. The changes in the thyroid axis and in prolactin secretion were almost the same in male and female patients. The data of this study suggest that endocrine disturbances in males are similar to those in females with anorexia nervosa, but differences exist mainly in relation to the gonadal axis.     

Factors Influencing Changes in Bone Mineral Density in Patients with Anorexia Nervosa-Related Osteoporosis: The Effect of Hormone Replacement Therapy

The purpose of this longitudinal study was to evaluate factors affecting changes in bone mineral density (BMD) in patients with anorexia nervosa (AN) and osteoporosis and, more particularly, to assess the benefits of hormone replacement therapy (HRT) on BMD in these patients. Our study involved 45 AN patients, 12 of whom had been treated by HRT for 2 years following a diagnosis of osteoporosis by densitometry (WHO criteria). Patients’ mean age was 25.3 ± 6.7 years. Mean duration of illness was 5.7 ± 5.3 years. Serum calcium and phosphate were measured at baseline, as were bone remodeling markers. Osteodensitometry by dual-energy X-ray absorptiometry was performed at inclusion and after 2 years. After 2 years, no significant differences were observed between spine, femoral neck, and total hip BMDs either in the HRT group (P = 0.3, P = 0.59, P = 0.58) or in the nontreatment group (P = 0.17, P = 0.68, P = 0.98). Moreover, there were no significant differences between the two groups when changes in spine, femoral neck, and total hip BMDs at 2 years were compared (P = 0.72, P = 0.95, P = 0.58). In both groups, change in weight at 1 year correlated with change in spine BMD at 2 years (r = 0.35, P = 0.04) and change in total-hip BMD at 2 years (r = 0.35, P = 0.04) but not with change in femoral neck BMD at 2 years. Patients with a body mass index (BMI) ≥ 17 kg/m² at 2 years showed a significant increase in total-hip BMD when compared with patients with a BMI < 17 kg/m² (+4.4% ± 6.7 vs. −0.5% ± 6.01, P = 0.03). No significant differences were observed for spine and femoral neck BMD. In patients who had recovered their menstrual cycle, significant increases were observed in spine BMD (+4% ± 6.3 vs. −1.9% ± 5.6, P = 0.008), femoral neck BMD (+3% ± 6.2 vs. −2.4% ± 8, P = 0.05), and total-hip BMD (+3% ± 7.1 vs. −3.7% ± 10, P = 0.04). Prevention of bone loss at 2 years in AN patients treated by HRT was not confirmed in this study. We did confirm that increase in weight at 1 year was the most predictive factor for the improvement of spine and hip BMD at 2 years.     

RANKL/RANK/OPG system and bone status in females with anorexia nervosa

Minimal data exist concerning the relationship between osteokines of the RANKL/RANK/OPG system, especially RANKL, and bone status in females with anorexia nervosa (AN). For this reason we investigated the relationship between bone metabolism (as assessed based on serum levels of OC and CTx), and OPG and sRANKL concentrations in females with AN. Ninety-one female patients with AN and 29 healthy female subjects aged 13 to 18 years of age participated in the study. Serum OC, CTx, OPG and sRANKL were measured by ELISA. The female patients with AN demonstrated an essential suppression of OC and CTx, increased OPG and sRANKL levels, and a reduced OPG/sRANKL ratio. OC, CTx and the OPG/sRANKL ratio correlated positively with body mass and BMI in these patients, whereas in the case of OPG and sRANKL the relationship was negative. A significant positive correlation was observed between OPG and sRANKL and also between bone markers and the OPG/sRANKL ratio, and negative between CTx and sRANKL. In female patients with AN, the OPG/RANKL ratio was a significant and independent predictor of osteocalcin, a bone formation marker — OC (R² = 0.065, p = 0.012) whereas the OPG/sRANKL ratio and BMI were significant and independent predictors of a bone resorption marker — CTx (R² = 0.095; p = 0.012). In conclusion, the body mass, BMI values, and bone markers suppression observed in female patients with AN might be associated with an increase in OPG and sRANKL levels and a significant decrease of the OPG/sRANKL ratio. Although higher OPG levels may compensate for excessive bone resorption in female patients with AN, the lower OPG/sRANKL ratio seems to indicate that some inadequacies exist regarding this compensation effect, which might contribute to low bone density in these patients. The OPG/sRANKL ratio might prove a more relevant marker to predict bone metabolism in female patients with AN than sRANKL and/or OPG alone.